Monday, December 14, 2009

Doctors And Nurses

You might not have heard of the Health Professional Entry Requirements 2009-2025 - Macro Supply and Demand Report before today, but the government has been sitting on it for some months now. Maybe that’s because they know they can never deliver the outcomes that are called for in the report, which looks at how many training places are needed to produce the doctors and nurses who will be required to serve the expected population in 2025.

According to the report, an additional 356 training places for doctors and more than 7000 for nurses are needed each year. This would require whole new medical schools to be established to cope with the increase, but as alarming as that is, it’s not the biggest problem. The real problem is finding places for medical graduates in training hospitals to gain critical clinical experience. It is an essential part of any doctor’s training, but even if university places are increased, there is nowhere for them to go.

Part of the reason for this is the fundamental flaw in planning which has left our hospitals struggling across the board. Some decades ago it was assumed that improved medical technology would result in patients leaving hospital sooner, reducing the need for beds, and the staff to service them. Decisions made then have left hospitals underfunded, under equipped and understaffed. What this means is that not only are there insufficient facilities for training new doctors, but even more alarmingly there are not enough senior doctors available to pass on their expertise.

One possible solution is to radically alter the nature of doctor training so that internships are served in general practice clinics, and plans for that to occur are well advanced. However, a general practice clinic is not a hospital and there is a real risk that doctors would not gain the same breadth of experience in such an environment. The fear is that it would amount to a kind of doctor-training-lite, and that’s why there should always be at least some in-hospital training for interns.

In the end, there is only one solution to the dilemma, and that is to properly fund the public hospital system. It comes down to the money, and the realisation that health funding is not just an expense, it is an investment. Decades of so called cost efficiency measures have eroded the ability of our hospitals to fulfill their vital functions, and first class medical training is one of them. In the end, cost cutting is very much like pruning the garden: it’s all very well to cut away the dead wood, but cutting too deeply will kill the bush.

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